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Zamstein O, Wainstock T, Sheiner E. Respiratory morbidity among offspring misclassified as growth restricted. Pediatr Pulmonol 2024; 59:1645-1651. [PMID: 38477629 DOI: 10.1002/ppul.26964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/16/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE An ultrasound-based diagnosis implies that some fetuses suspected to be growth-restricted (FGR) are discovered at birth to be appropriately grown (appropriate for gestational age [AGA] birth weight, between the 10th and 90th percentile). These fetuses may thus be exposed to unnecessary medical interventions, including early labor induction. In this study, we have evaluated the long-term respiratory health of offspring misclassified as FGR. STUDY DESIGN A population-based cohort analysis was conducted, including deliveries of AGA singletons between 1991 and 2021 at a tertiary referral hospital. Incidence of morbidity due to various respiratory conditions was compared between AGA offspring with prenatal diagnosis of FGR, and those without a false diagnosis of FGR. The Kaplan-Meier approach was used to estimate cumulative morbidity incidence. The stratified Cox proportional-hazards model was used to control for confounders. RESULTS A total of 324,620 deliveries of AGA newborns were included in the analyses; 3249 of them (1.0%) were misclassified prenatally as FGR. The FGR subgroup delivered at an earlier gestational age (36.7 vs. 39.1 weeks, p < .001) and had more than 25% higher incidence of respiratory-related morbidity during childhood (33.2% vs. 26.5%), specifically related to asthma and obstructive sleep apnea (p < .001 for all). A higher cumulative morbidity rate due to respiratory conditions was observed in the Kaplan-Meier survival curve (log-rank p value < .001). This association between FGR and respiratory morbidity was independent of preterm delivery, maternal age, cesarean delivery, and child's birth year (adjusted hazard ratio = 1.14, 95% confidence interval: 1.07-1.21, p < .001), using a Cox proportional hazards model. CONCLUSION AGA newborns misclassified as FGR, are at an increased risk for long-term respiratory morbidity during childhood and adolescence.
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Affiliation(s)
- Omri Zamstein
- Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Benbassat J. Trust in public health policy in the time of the COVID-19 epidemic in Israel. Isr J Health Policy Res 2024; 13:24. [PMID: 38664713 PMCID: PMC11044392 DOI: 10.1186/s13584-024-00607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
The government of Israel provides universal health care through four health care organizations ("sick funds") that enjoy general public trust. In hindsight, the response of the government to the COVID-19 epidemic seems reasonable. In the first year of the epidemic, tests and vaccines were developed and other measures were taken, including social distancing, focusing on risk factors for infection and disease severity, and improving treatment. The COVID-19 mortality rate between January 2000 and June 2021 was around 750 per million inhabitants, well below the OECD average of 1300. Still, although the control measures were largely well received, the media and an ad hoc non-governmental Emergency Council for the coronavirus crisis in Israel criticized the government's response to the epidemic thereby contributing to a decline in public trust in government policy. This commentary provides an overview of the importance of trust in medical institutions and the difficulties of evaluating healthcare decisions in an attempt to justify three conclusions. First, when physicians and self-appointed experts publicly disapprove of a government policy, they should consider the trade-off between improving care and undermining public trust. Second, when evaluating a medical decision, experts should not ask, "Would I have acted differently?" but rather, "Was the decision under review completely unreasonable?" Thirdly, criticism is certainly worth listening to. However, I believe that by calling for organized resistance against the government, the publicly announced establishment of the Emergency Council for the Corona crisis blatantly crossed the line between constructive criticism and destructive mistrust.
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Affiliation(s)
- Jochanan Benbassat
- Department of Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel.
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Zamstein O, Sheiner E, Binyamin Y, Pariente G, Wainstock T. Examining the relationship between autism spectrum disorder in children whose mother had labour epidural analgesia for their birth: A retrospective cohort study. Eur J Anaesthesiol 2024; 41:282-287. [PMID: 38084085 DOI: 10.1097/eja.0000000000001932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Controversy exists regarding the association between autism spectrum disorder (ASD) in children whose mother had labour epidural analgesia for their birth, as the few existing investigations have reported mixed findings. OBJECTIVE This study aims to evaluate the possibility of an association in our heterogeneous population. DESIGN A retrospective population-based cohort study. SETTING Vaginal deliveries that took place between the years 2005 and 2017 at Soroka University Medical Center, a tertiary referral hospital in Israel, and a follow-up on the incidence of ASD in the children. PATIENTS A hundred and thirty-nine thousand, nine hundred and eighty-one labouring patients and their offspring. MAIN OUTCOME MEASURES The incidence of children diagnosed with ASD (both hospital and community-based diagnoses) was compared based on whether their mothers had received labour epidural analgesia during their labour. A Kaplan-Meier survival curve compared cumulative incidence of ASD. A Cox proportional hazards model was used to control for relevant confounders. RESULTS Labour epidural analgesia was administered to 33 315 women. Epidural analgesia was more common among high-risk pregnancy groups (including pregnancies complicated with diabetes mellitus, hypertensive disorders, intrauterine growth restriction, and oligohydramnios; P < 0.001). In a Cox proportional hazards model, the association between epidural analgesia during labour and ASD in the children lost statistical significance following adjustment for confounders such as maternal age, gestational age, hypertensive disorders, diabetes mellitus, and ethnicity [adjusted hazard ratio = 1.13, 95% confidence interval (CI), 0.96 to 1.34, P = 0.152]. CONCLUSION In our population, after adjusting for confounders, epidural analgesia is not independently associated with autism spectrum disorder in the children. These findings enhance our knowledge regarding the safety of epidural analgesia and enable patients to make informed decisions about their pain relief techniques during labour.
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Affiliation(s)
- Omri Zamstein
- From the Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (OZ, ES, GP), Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (YB) and Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (TW)
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Zhang J, Zhu S, Liu C, Hu Y, Yang A, Zhang Y, Hong Y. Global, regional and national burden of ischemic stroke attributed to high low-density lipoprotein cholesterol, 1990-2019:A decomposition analysis and age-period-cohort analysis. J Cereb Blood Flow Metab 2024; 44:527-541. [PMID: 37891501 PMCID: PMC10981397 DOI: 10.1177/0271678x231211448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/11/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
High levels of low-density lipoprotein cholesterol (LDL-C) have been associated with an augmented mortality of ischemic stroke. The yearly deaths and mortality data of IS-hLDL-C were derived from the global burden of disease 2019 dataset. The joinpoint, age-period-cohort and decomposition analysis were utilized to evaluate the long-term patterns in the disease burden of IS-hLDL-C, and the effects of population growth and aging. Globally, in 2019, 0.61 million ischemic stroke-related deaths were attributable to high LDL-C, with the highest death burden in the high-middle socio-demographic index (SDI) region. From 1990 to 2019, the age-standardized death rate (ASDR) for IS-hLDL-C exhibited a downward trend, with an average annual percentage change of -1.69 [95% confidence interval: -1.90, -1.48)]. The fastest decreasing trends in ASDR were experienced in the high SDI region. In 119 (58.33%) countries, aging increased the disease burden of hLDL-IS, and population growth increased the disease burden of IS-hLDL-C in 163 (79.90%) countries. The trend in disease burden of IS-hLDL-C exhibited variation across countries and regions, particularly in territories with high to middle high SDI. Aging in upper to middle-income countries and population growth in low to middle-income countries further offset endeavors to reduce the burden of ischemic stroke deaths.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
- Department of Neurosurgery, the Seventh Clinical College of China Medical University, Fushun, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Chunlong Liu
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Yaofeng Hu
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Aoran Yang
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yonghui Zhang
- Department of Neurosurgery, the Seventh Clinical College of China Medical University, Fushun, China
| | - Yang Hong
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
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Barasche-Berdah D, Ein-Mor E, Calderon-Margalit R, Rose AJ, Krieger M, Brammli-Greenberg S, Ben-Yehuda A, Manor O, Cohen AD, Bar-Ratson E, Bareket R, Matz E, Paltiel O. Nationwide Evaluation of Quality of Care Indicators for Individuals with Severe Mental Illness and Diabetes Mellitus, Following Israel's Mental Health Reform. Community Ment Health J 2024; 60:354-365. [PMID: 37697183 DOI: 10.1007/s10597-023-01178-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/31/2023] [Indexed: 09/13/2023]
Abstract
Diabetes Mellitus (DM) is more common among individuals with severe mental illness (SMI). We aimed to assess quality-of-care-indicators in individuals with SMI following the 2015 Israel's Mental-Health-reform. We analyzed yearly changes in 2015-2019 of quality-of-care-measures and intermediate-DM-outcomes, with adjustment for gender, age-group, and socioeconomic status (SES) and compared individuals with SMI to the general adult population. Adults with SMI had higher prevalences of DM (odds ratio (OR) = 1.64; 95% confidence intervals (CI): 1.61-1.67) and obesity (OR = 2.11; 95% CI: 2.08-2.13), compared to the general population. DM prevalence, DM control, and obesity rates increased over the years in this population. In 2019, HbA1c testing was marginally lower (OR = 0.88; 95% CI: 0.83-0.94) and uncontrolled DM (HbA1c > 9%) slightly more common among patients with SMI (OR = 1.22; 95% CI: 1.14-1.30), control worsened by decreasing SES. After adjustment, uncontrolled DM (adj. OR = 1.02; 95% CI: 0.96-1.09) was not associated with SMI. Cardio-metabolic morbidity among patients with SMI may be related to high prevalences of obesity and DM rather than poor DM control. Effective screening for metabolic diseases in this population and social reforms are required.
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Affiliation(s)
- Deborah Barasche-Berdah
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel.
| | - Eliana Ein-Mor
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Adam J Rose
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Michal Krieger
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Shuli Brammli-Greenberg
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arye Ben-Yehuda
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arnon D Cohen
- Clalit Health Services, 101 Arlozorov St., POB 16250, 62098, Tel Aviv, Israel
| | | | - Ronen Bareket
- Meuhedet Health Fund, 124 Ibn Gvirol St, 62038, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Medical Education, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Matz
- Leumit Health Fund, 23 Sprinzak St, 64738, Tel Aviv, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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Muhsen K, Cohen D, Glatman-Freedman A, Husseini S, Perlman S, McNeil C. Review of Israel's action and response during the COVID-19 pandemic and tabletop exercise for the evaluation of readiness and resilience-lessons learned 2020-2021. Front Public Health 2024; 11:1308267. [PMID: 38328537 PMCID: PMC10847317 DOI: 10.3389/fpubh.2023.1308267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024] Open
Abstract
Background Reevaluating response plans is essential to ensuring consistent readiness and resilience to the COVID-19 pandemic. The "During Action Review" and Tabletop (DART) methodology provides a retrospective and prospective assessment to inform the adaptive response. Israel introduced COVID-19 vaccinations in December 2020 and was the first country to implement booster vaccination to address waning immunity and surges caused by new variants. We assessed Israel's readiness and resilience related to COVID-19 response while capturing the pre-vaccination and vaccination periods. Methods A DART analysis was conducted between December 2020 and August 2021 among experts involved in the management of the COVID-19 pandemic in Israel. During the retrospective stage, a role-based questionnaire and discussions were undertaken in a participant-led review of the response, focusing on epidemiology and surveillance, risk communication, and vaccines. The prospective stage included tabletop exercises to evaluate short to long-term simulated scenarios. Results Participants emphasized the pivotal role of Israel globally by sharing experiences with the pandemic, and vaccination. Perceived strengths included multi-sectoral collaboration between the Ministry of Health, healthcare providers, academia, military, and others, stretching capacities, expanding laboratory workload, and establishing/maintaining surveillance. The vaccine prioritization plan and strong infrastructure, including computerized databases, enabled real-life assessment of vaccine uptake and impact. Challenges included the need to change case definitions early on and insufficient staffing. Quarantine of patients and contacts was particularly challenging among underprivileged communities. Risk communication approaches need to focus more on creating norms in behavior. Trust issues and limited cooperation were noted, especially among ethnic and religious minorities. To ensure readiness and resiliency, participants recommended establishing a nationally deployed system for bringing in and acting upon feedback from the field, especially concerning risk communication and vaccines. Conclusion Our study appraised strengths and weaknesses of the COVID-19 pandemic response in Israel and led to concrete recommendations for adjusting responses and future similar events. An efficient response comprised multi-sectoral collaboration, policy design, infrastructure, care delivery, and mitigation measures, including vaccines, while risk communication, trust issues, and limited cooperation with minority groups were perceived as areas for action and intervention.
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Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Middle East Consortium on Infectious Disease Surveillance, Jerusalem, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Middle East Consortium on Infectious Disease Surveillance, Jerusalem, Israel
| | - Aharona Glatman-Freedman
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Sari Husseini
- Middle East Consortium on Infectious Disease Surveillance, Jerusalem, Israel
| | - Saritte Perlman
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Leventhal-Perek S, Shani M, Schonmann Y. Effectiveness and persistence of anti-obesity medications (liraglutide 3 mg, lorcaserin, and orlistat) in a real-world primary care setting. Fam Pract 2023; 40:629-637. [PMID: 36477550 DOI: 10.1093/fampra/cmac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity is a chronic disease with rising prevalence. Guidelines suggest medications for obesity management if lifestyle interventions do not lead to substantial weight loss. Randomized control trials have shown the efficacy of anti-obesity medications in inducing weight loss, but real-world data are lacking. Therefore, our study aims to evaluate anti-obesity medications' effectiveness in reducing weight and improving cardiometabolic parameters and to assess their persistence in a real-world setting. METHODS A historical cohort study using routinely collected data from Clalit Health Services (CHS). We retrieved data on all CHS members aged ≥20 years who initiated anti-obesity medication (orlistat, liraglutide 3 mg, and lorcaserin) between 2018 and 2020. We assessed average weight loss and the percentage of patients that had lost ≥5% and ≥10% of their body weight at 3, 6, and 9 months and compared the effectiveness of these 3 medications. RESULTS We included 5,306 CHS members in our study; most (77.8%) were female, aged 40-59 years (52.4%). Treatment with liraglutide 3 mg and lorcaserin was associated with subsequent weight reduction. The average weight loss at 6 months was 5.6 kg (4.95-6.25, 95% confidence interval [CI]) with liraglutide 3 mg and 1.7 kg (1.2-2.2, 95% CI) with lorcaserin. There was no evidence that treatment with orlistat was associated with subsequent weight loss (-0.18 kg [-0.8 to 0.4, 95% CI]). At 6 months, 38% of the patients with orlistat, 43% with lorcaserin, and 51% with liraglutide 3 mg persisted with their treatments (P < 0.001). CONCLUSION Liraglutide 3 mg was the primary medication associated with clinically significant weight loss and had the highest persistence rate in our real-world study.
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Affiliation(s)
- Sharon Leventhal-Perek
- Department of Family Medicine, Tel Aviv District, Clalit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Shani
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Family Medicine, Central District, Clalit Health Service, Rehovot, Israel
| | - Yochai Schonmann
- Department of Family Medicine, Tel Aviv District, Clalit Health Services, Tel Aviv, Israel
- Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Tarabeih M, Perelmutter O, Kitay-Cohen Y, Amiel A, Na'amnih W. Associations of the COVID-19 burden and various comorbidities of different ethnic groups in Israel: a cross-sectional study. Clin Exp Med 2023; 23:4891-4899. [PMID: 37658247 DOI: 10.1007/s10238-023-01172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
Coronavirus disease (COVID-19) is highly transmissible between human beings. We examined differences in the core families with COVID-19 severity and mortality and comorbidities between Arab and Jews and explored the factors associated with COVID-19 severity and mortality to find a genetic component. A cross-sectional study was conducted among 2240 COVID-19 patients (> 18 years of age) randomly selected by online panels and questionnaires in the native language (Hebrew or Arabic) during March 2021-June 2022. Multivariable linear regression models were used to assess correlations with COVID-19 disease severity and mortality. Overall, 1549 (69%) were Arabs and 691 (31%) were Jews. The proportion of participants who died from COVID-19 was higher among Arabs compared with Jews (66% vs. 59%), P < 0.001. The mean number of deaths from COVID-19 and patients with severe COVID-19 was higher in ultra-Orthodox Jewish, non-academic core families and those who lived in the city residence compared with secular, academic core families and who live in the village residence, P < 0.001. A multivariable linear regression model showed a significant association between metabolic, kidney, cardiovascular, and respiratory diseases with COVID-19 severity (B coefficient - 0.43, B coefficient - 0.53, B coefficient - 0.53, B coefficient - 0.42, respectively) and COVID-19 mortality (B coefficient - 0.51, B coefficient - 0.64, B coefficient - 0.67, B coefficient - 0.34, respectively), P < 0.001. COVID-19 severity and mortality were highly associated with comorbidities, ethnicity, social and environmental factors. Furthermore, we believe that genetic factors also contribute to the increase in COVID-19 severity and mortality and the differences rates of these between Arabs and Jews in Israel.
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Affiliation(s)
- Mahdi Tarabeih
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, 2 Rabenu Yerucham St., P.O.B 8401, 61083, Tel Aviv, Israel.
| | | | - Yona Kitay-Cohen
- Internal Medicine C, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aliza Amiel
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, 2 Rabenu Yerucham St., P.O.B 8401, 61083, Tel Aviv, Israel
| | - Wasef Na'amnih
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, 2 Rabenu Yerucham St., P.O.B 8401, 61083, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hammerman A, Azran C, Topol Y, Landsberger D, Liebermann N, Siegelmann-Danieli N. Publicly Funded Cancer Care: Are Adjuvant Therapies Prioritized Over Treatment of Metastatic Cancer? The Israeli Experience. JCO Oncol Pract 2023:OP2300213. [PMID: 37967295 DOI: 10.1200/op.23.00213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
PURPOSE In Israel, a public committee advises which new medications should be reimbursed subject to an annual budget allocation. The committee considers clinical trial outcomes, professional societies' preferences, projected budget impacts, and other social and ethical aspects. The Israeli oncologists' society places a strong emphasis on prioritizing adjuvant therapies because of their potential to advance cure. In 2023, several novel adjuvant therapies were suggested for national funding. Our objective was to ascertain whether Israeli decision makers have embraced the practice of prioritizing budgets for therapies with curative intent over late-disease therapy. METHODS We collected data on all proposed cancer therapies for the 2023 update: indications, treatment settings, European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) score, and whether accepted for reimbursement. The rates of acceptance were compared between drugs in curative and noncurative settings. Data were extracted from the official Israeli Ministry of Health publications and ESMO-MCBS website. RESULTS Seven of the eight proposed therapies with curative intent received reimbursement approval (88%), in contrast to 11 of the 55 therapies for advanced/metastatic stages (20%). Among all advanced disease therapies with a high ESMO-MCBS score of 4, only four of 16 (25%) secured reimbursement approval. CONCLUSION Our analysis revealed that during the 2023 reimbursement deliberations, Israeli policymakers embraced the prioritization of potentially curative therapies over treatments for incurable cancers, including several interventions that have demonstrated significant improvements in overall survival and/or quality of life. Introducing objective cost-effectiveness measures as a guiding framework for comparing competing medications may offer some resolution to this complex challenge.
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Affiliation(s)
| | - Carmil Azran
- Maccabi Health Services Headquarters, Tel-Aviv, Israel
| | - Yael Topol
- Maccabi Health Services Headquarters, Tel-Aviv, Israel
| | | | | | - Nava Siegelmann-Danieli
- Maccabi Health Services Headquarters, Tel-Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Luxenburg O, Morginstin T, Myers V, Saban M, Shemer J, Wilf-Miron R. Priority setting for health technology adoption at the national level: Lessons learned over 25 years' experience. Int J Technol Assess Health Care 2023; 39:e71. [PMID: 37929308 DOI: 10.1017/s0266462323002611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Limited health budgets and continual advancement of health technologies require mechanisms for prioritization. Israel, with a publicly funded health service basket, has implemented and optimized such a health technology assessment process since 1999.We describe the process of evaluating technologies according to the Israeli model, analyze its outputs and benefits over two decades of implementation, and compare its key features with international experience. METHODS Retrospective data were collected between 1998 and 2023, including work processes, committee composition, number of applications submitted and approved by a clinical domain, and yearly cost of the basket. Features were evaluated within the evidence-informed deliberative process (EDP) framework. RESULTS This national model involves relevant stake holders in a participatory and transparent process, in a timely manner, and is accepted by the public, health professionals, and policy makers, facilitating early adoption of the newest medical technologies. Between 11 and 19 percent of applications are approved for reimbursement annually, mostly pharmaceuticals. On average 26 percent of approved technologies are added to the list without additional budget. Major domains of approved technologies were oncology, cardiology, and neurology. CONCLUSIONS Israel created a unique model for the expansion of the health service basket. Despite an increasing number of applications and rising costs, the mechanism enables a consensus to be reached on which technologies to fund, while remaining within budget constraints and facilitating immediate implementation. The process, which prioritizes transparency and stake holder involvement, allows just a resource allocation while maximizing the adoption of novel technologies, contributing to an outstanding national level of health despite relatively low health spending.
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Affiliation(s)
- Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Tal Morginstin
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Vicki Myers
- Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Saban
- Department of Nursing, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Rachel Wilf-Miron
- Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shalev Many Y, Shvartzman P, Wolf I, Silverman BG. Place of Death for Israeli Cancer Patients Over a 20-Year Period: Reducing Hospital Deaths, but Barriers Remain. Oncologist 2023; 28:e1092-e1098. [PMID: 37260398 PMCID: PMC10628558 DOI: 10.1093/oncolo/oyad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/19/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Cancer remains a leading cause of mortality worldwide. While the main focus of palliative care (PC) is quality of life, the elements that comprise the quality of death are often overlooked. Dying at home, with home-hospice-care (HHC) support, rather than in-hospital, may increase patient satisfaction and decrease the use of invasive measures. We examined clinical and demographic characteristics associated with out-of-hospital death among patients with cancer, which serves as a proxy measure for HHC deaths. METHODS Using death certification data from the Israel Central Bureau of Statistics, we analyzed 209,158 cancer deaths between 1998 and 2018 in Israel including demographic information, cause of death, and place of death (POD). A multiple logistic regression model was constructed to identify factors associated with out-of-hospital cancer deaths. RESULTS Between 1998 and 2018, 69.1% of cancer deaths occurred in-hospital, and 30.8% out-of-hospital. Out-of-hospital deaths increased by 1% annually during the study period. Older patients and those dying of solid malignancies were more likely to die out-of-hospital (OR = 2.65, OR = 1.93, respectively). Likelihood of dying out-of-hospital varied with area of residency; patients living in the Southern district were more likely than those in the Jerusalem district to die out-of-hospital (OR = 2.37). CONCLUSION The proportion of cancer deaths occurring out-of-hospital increased during the study period. We identified clinical and demographic factors associated with POD. Differences between geographical areas probably stem from disparity in the distribution of PC services and highlight the need for increasing access to primary EOL care. However, differences in age and tumor type probably reflect cultural changes and suggest focusing on educating patients, families, and physicians on the benefits of PC.
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Affiliation(s)
| | - Pesach Shvartzman
- Pain and Palliative Care Unit, Department of Family Medicine, Ben Gurion University, Beer Sheva, Israel
| | - Ido Wolf
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Barbara G Silverman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel National Cancer Registry, Israel Ministry of Health, Ramat Gan, Israel
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Bilu Y, Flaks-Manov N, Goldshtein I, Bivas-Benita M, Akiva P, Bodenheimer G, Greenfeld S. Youth Mental Health Outcomes up to Two Years After SARS-CoV-2 Infection Long-COVID or Long-Pandemic Syndrome: A Retrospective Cohort Study. J Adolesc Health 2023; 73:701-706. [PMID: 37389526 DOI: 10.1016/j.jadohealth.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Youth mental distress has substantially increased during the COVID-19 pandemic. However, it is unclear if mental symptoms are directly related to SARS-CoV-2 infection or to social restrictions. We aimed to investigate mental health outcomes in infected versus uninfected adolescents, for up to two years after an index polymerase chain reaction (PCR) test. METHODS A retrospective cohort study, based on electronic health records from a large nationally representative Israeli health fund, among adolescents aged 12-17 years with a PCR test for SARS-CoV-2 between March 1, 2020 and March 1, 2021. Infected and uninfected individuals were matched by age, sex, test date, sector, and socioeconomic status. Cox regression was used to derive hazard ratios (HRs) for mental health outcomes within two years from PCR test for infected versus uninfected individuals, while accounting for pre-existing psychiatric history. External validation was performed on UK primary care data. RESULTS Among 146,067 PCR-tested adolescents, 24,009 were positive and 22,354 were matched with negative adolescents. SARS-CoV-2 infection was significantly associated with reduced risks for dispensation of antidepressants (HR 0.74, 95% confidence interval [CI] 0.66-0.83), diagnoses of anxiety (HR 0.82, 95% CI 0.71-0.95), depression (HR 0.65, 95% CI 0.53-0.80), and stress (HR 0.80, 95% CI 0.69-0.92). Similar results were obtained in the validation dataset. DISCUSSION This large, population-based study suggests that SARS-CoV-2 infection is not associated with elevated risk for mental distress in adolescents. Our findings highlight the importance of taking a holistic view on adolescents' mental health during the pandemic, with consideration of both SARS-CoV-2 infection and response measures.
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13
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Tal O, Barnea R, Tur-Sinai A. Patient-centeredness-a cultural targeted survey among junior medical managers. Int J Equity Health 2023; 22:170. [PMID: 37649063 PMCID: PMC10469801 DOI: 10.1186/s12939-023-01979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Patient-centeredness is a core element in healthcare. However, there is a gap between the understanding of this term by healthcare professionals, and patients' capability, self-efficacy, and willingness to take part in medical decisions. We aim to expose standpoints toward "patient centeredness" among junior medical managers (JMM), as they bridge between policy strategies and patients. We try to reveal cultural differences by comparing the views of the majority and the minority subpopulations of Israel (Arabic and Hebrew speakers). METHODS A cross-sectional survey among JMM studying for an advanced degree in health-system management at three academic training colleges in Israel was conducted in February-March 2022. The respondents completed a structured questionnaire comprising four sections: a) perceptions of trust, accountability, insurance coverage, and economic status; b) perceptions regarding decision-making mechanisms; c) preferences toward achieving equity, and d) demographic details. RESULTS A total of 192 respondents were included in the study-50% Hebrew speakers and 50% Arabic speakers. No differences were found between Arabic and Hebrew speakers regarding perception of trust, accountability, insurance coverage, and economic status. JMM from both subpopulations believed that patients' gender and age do not influence physicians' attitudes but Arabic-speaking respondents perceived that healthcare professionals prefer educated patients or those with supportive families. All respondents believed that patients would like to be more involved in medical decisions; yet Arabic-speakers perceived patients as tending to rely on physicians' recommendations while Hebrew speakers believed that patients wish to lead the medical decision by themselves. CONCLUSIONS Patient-centeredness strategy needs to be implemented bottom-up as well as top-down, in a transparent nationwide manner. JMM are key actors in carrying out this strategy because they realize policy guidelines in the context of social disparities, enabling them to achieve a friendly personalized dialogue with their patients. We believe that empowering these JMM may create a ripple effect, yielding a bottom-up perception of equity and initiating change.
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Affiliation(s)
- Orna Tal
- Shamir Medical Center, Be'er Yaakov, Israel.
- Bar-Ilan University, Ramat Gan, Israel.
- ICET, Israeli Center for Emerging Technologies, Beer Yaakov, Israel.
| | - Royi Barnea
- Assuta Health Services Research Institue, Assuta Medical Centers, Tel Aviv, Israel
- School of Health Systems Management, Netanya Academic College, Netanya, Israel
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
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14
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Mari A, Na'amnih W, Ghantous L, Ahmad HS, Khoury T, Muhsen K. Quality of life and severity of symptoms among patients with various degrees of reflux esophagitis: a prospective study. Sci Rep 2023; 13:13970. [PMID: 37634042 PMCID: PMC10460377 DOI: 10.1038/s41598-023-41332-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/24/2023] [Indexed: 08/28/2023] Open
Abstract
Gastro-esophageal reflux disease (GERD) can cause erosive esophagitis (EE) and compromise the quality of life (QoL). We examined differences in symptom severity and QoL according to EE severity grade. A follow-up study was conducted among GERD patients at the Nazareth Hospital in Israel. Patients underwent a baseline gastroscopy in 2014-2020 during which the EE grade was determined using the Los Angeles classification. Follow-up telephone interviews were conducted during 2019-2020 with a mean time interval of 18.9 months (SD = 14.9) after the baseline gastroscopy to assess GERD symptoms using the Reflux disease questionnaire (RDQ) and QoL using the GERD QoL questionnaire. The patients were interviewed in their native language (Arabic or Hebrew). Overall, 149 (66.4% males) patients were included; 50 had EE grades C/D and 99 had grades A/B. The mean age at baseline and follow-up was 44.6 years (SD = 15.1) and 46.2 years (SD = 14.9), respectively. Cronbach's alpha was 0.928 and 0.855 for the RDQ and QoL questionnaires, respectively. Patients with EE C/D grades had more severe symptoms than patients with EE A/B grades (P = 0.05), especially in regurgitation scores (P = 0.03). Females had more severe symptoms (overall) than males (adjusted OR = 2.34; 95% CI 1.12-4.90). Patients with the more severe esophagitis EE C/D group (adjusted OR = 1.98; 95% CI 0.93-4.24) and those who used PPIs treatment (adjusted OR = 2.19; 95% CI 0.95-5.01) reported more severe GERD symptoms. The number of schooling years was significantly associated with better QoL score (beta coefficient 1.33, P = 0.005) but not EE grade or GERD symptoms. Follow-up endoscopy conducted among 22 patients with EE grades C/D showed that 13 (59.1%) of these patients had normal endoscopic findings, 6 patients (27.3%) had a grade A EE, 1 patient (4.5%) had grade B, and 2 (9.1%) remained with grade C EE. The Arabic and Hebrew versions of the RDQ and QoL questionnaires were highly reliable. GERD symptoms severity was more profound among patients with more severe esophagitis. No significant association between EE grade and QoL; this negative result might be due to the improvement in esophagitis endoscopic findings among patients with C/D grade.
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Affiliation(s)
- Amir Mari
- Gastroenterology Department, Azrieli Faculty of Medicine, Gastroenterology and Hepatology Institute, Nazareth Hospital, Bar Ilan University, 16100, Nazareth, Israel.
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Wasef Na'amnih
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Loay Ghantous
- Internal Medicine Department, Azrieli Faculty of Medicine, Nazareth Hospital, Bar Ilan University, Nazareth, Israel
| | - Helal Said Ahmad
- Gastroenterology Department, Azrieli Faculty of Medicine, Gastroenterology and Hepatology Institute, Nazareth Hospital, Bar Ilan University, 16100, Nazareth, Israel
| | - Tawfik Khoury
- Gastroenterology Department, Azrieli Faculty of Medicine, Gastroenterology and Hepatology Institute, Nazareth Hospital, Bar Ilan University, 16100, Nazareth, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Furman-Assaf S, Accos-Carmel M, Kolobov T, Blaychfeld-Magnazi M, Endevelt R, Tamir O. Attitudes and perceived knowledge of health professionals on the food labelling reform in Israel. Public Health Nutr 2023; 26:1513-1521. [PMID: 36919667 PMCID: PMC10346017 DOI: 10.1017/s1368980023000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To assess the attitudes and perceived knowledge of health professionals regarding the food product judgemental-labelling reform that began in January 2020 in Israel. DESIGN Cross-sectional survey. SETTINGS An online survey among health professionals working in the Israeli health system. PARTICIPANTS 456 participants (118 physicians, 207 nurses, 131 nutritionists). RESULTS Most respondents (89·9 %) were women, 36 % had over 20 years of professional experience. All nutritionists, 96·6 % of physicians and 94·7 % of nurses reported hearing about the reform, and most (88·9 % of nurses, 76·3 % of physicians and 75·6 % of nutritionists) claimed supporting the reform to a great or very great extent. Most respondents believe they should discuss issues related to healthy eating with their patients (91·8 % of nurses, 94·9 % of physicians and all nutritionists), but only about half (47·5 % of physicians and 57·0 % of nurses) reported that they have sufficient knowledge in this field, particularly about food labelling. Almost two-thirds of nutritionists (60·3 %) reported instructing patients to change their food intake according to labelling v. 40·1 % and 34·7 % of nurses and physicians, respectively. Only some respondents felt that they could influence their patients' nutrition habits. Most participants believe that additional regulatory measures should also be used to promote healthy nutrition. CONCLUSIONS There is a gap between the desire of physicians and nurses to provide nutritional guidance to the public and their actual knowledge about the labels' meaning as well as their competencies in providing nutrition counselling. When formulating a reform, policymakers should provide clear guidelines about the expectations of implementing it in therapeutic practice.
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Affiliation(s)
- Sharon Furman-Assaf
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Moran Accos-Carmel
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Tatyana Kolobov
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Moran Blaychfeld-Magnazi
- Ministry of Health, Jerusalem, Israel
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Ronit Endevelt
- Ministry of Health, Jerusalem, Israel
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Orly Tamir
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
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16
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Lapidot Y, Maya M, Reshef L, Cohen D, Ornoy A, Gophna U, Muhsen K. Relationships of the gut microbiome with cognitive development among healthy school-age children. Front Pediatr 2023; 11:1198792. [PMID: 37274812 PMCID: PMC10235814 DOI: 10.3389/fped.2023.1198792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/05/2023] [Indexed: 06/07/2023] Open
Abstract
Background The gut microbiome might play a role in neurodevelopment, however, evidence remains elusive. We aimed to examine the relationship between the intestinal microbiome and cognitive development of school-age children. Methods This cross-sectional study included healthy Israeli Arab children from different socioeconomic status (SES). The microbiome was characterized in fecal samples by implementing 16S rRNA gene sequencing. Cognitive function was measured using Stanford-Binet test, yielding full-scale Intelligence Quotient (FSIQ) score. Sociodemographics and anthropometric and hemoglobin measurements were obtained. Multivariate models were implemented to assess adjusted associations between the gut microbiome and FSIQ score, while controlling for age, sex, SES, physical growth, and hemoglobin levels. Results Overall, 165 children (41.2% females) aged 6-9 years were enrolled. SES score was strongly related to both FSIQ score and the gut microbiome. Measures of α-diversity were significantly associated with FSIQ score, demonstrating a more diverse, even, and rich microbiome with increased FSIQ score. Significant differences in fecal bacterial composition were found; FSIQ score explained the highest variance in bacterial β-diversity, followed by SES score. Several taxonomic differences were significantly associated with FSIQ score, including Prevotella, Dialister, Sutterella, Ruminococcus callidus, and Bacteroides uniformis. Conclusions We demonstrated significant independent associations between the gut microbiome and cognitive development in school-age children.
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Affiliation(s)
- Yelena Lapidot
- Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maayan Maya
- Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leah Reshef
- The Shmunis School of Biomedicine and Cancer Research, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asher Ornoy
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Medical Neurobiology, The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Uri Gophna
- The Shmunis School of Biomedicine and Cancer Research, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zamstein O, Wainstock T, Sheiner E. Intrapartum Maternal Fever and Long-Term Infectious Morbidity of the Offspring. J Clin Med 2023; 12:jcm12093329. [PMID: 37176769 PMCID: PMC10179301 DOI: 10.3390/jcm12093329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring's tendency to long-term infectious morbidity. A population-based cohort analysis including deliveries between 1991 and 2021 was conducted. The incidence of hospitalizations of the offspring up to the age of 18 years, due to various infectious conditions, was compared between pregnancies complicated by intrapartum fever and those that were not. A Kaplan-Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Overall, 538 of the 356,356 included pregnancies were complicated with fever. A higher rate of pediatric hospitalizations due to various infectious conditions was found among the exposed group, which was significant for viral, fungal and ENT infections (p < 0.05 for all). The total number of infectious-related hospitalizations was significantly higher (30.1% vs. 24.1%; OR = 1.36; p = 0.001), as was the cumulative incidence of hospitalizations. This association remained significant after controlling for confounders using a Cox proportional hazards model (adjusted HR = 1.21; 95% CI 1.04-1.41, p = 0.016). To conclude, fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections.
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Affiliation(s)
- Omri Zamstein
- The Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva POB 653, Israel
| | - Eyal Sheiner
- The Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel
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Shadmi E, Khatib M, Spitzer S. The COVID-19 Israeli tapestry: the intersectionality health equity challenge. Isr J Health Policy Res 2023; 12:17. [PMID: 37098624 PMCID: PMC10129307 DOI: 10.1186/s13584-023-00567-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/20/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND COVID-19 is disproportionately affecting disadvantaged populations, with greater representation and worse outcomes in low socioeconomic and minority populations, and in persons from marginalized groups. General health care system approaches to inequity reduction (i.e., the minimization of differences in health and health care which are considered unfair or unjust), address the major social determinants of health, such as low income, ethnic affiliation or remote place of residents. Yet, to effectively reduce inequity there is a need for a multifactorial consideration of the aspects that intersect and generate significant barriers to effective care that can address the unique situations that people face due to their gender, ethnicity and socioeconomic situation. MAIN BODY To address the health equity challenges of diverse population groups in Israel, we propose to adopt an intersectional approach, allowing to better identify the needs and then better tailor the infection prevention and control modalities to those who need them the most. We focus on the two main ethnic - cultural-religious minority groups, that of Arab Palestinian citizens of Israel and Jewish ultra-orthodox (Haredi) communities. Additionally, we address the unique needs of persons with severe mental illness who often experience an intersection of clinical and sociodemographic risks. CONCLUSIONS This perspective highlights the need for responses to COVID-19, and future pandemic or global disasters, that adopt the unique lens of intersectionality and equity. This requires that the government and health system create multiple messages, interventions and policies which ensure a person and community tailored approach to meet the needs of persons from diverse linguistic, ethnic, religious, socioeconomic and cultural backgrounds. Under-investment in intersectional responses will lead to widening of gaps and a disproportionate disease and mortality burden on societies' most vulnerable groups.
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Affiliation(s)
- Efrat Shadmi
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | | | - Sivan Spitzer
- Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
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19
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Kaim A, Saban M. Dynamic Trends in Sociodemographic Disparities and COVID-19 Morbidity and Mortality—A Nationwide Study during Two Years of a Pandemic. Healthcare (Basel) 2023; 11:healthcare11070933. [PMID: 37046860 PMCID: PMC10094509 DOI: 10.3390/healthcare11070933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Social epidemiological research has documented that health outcomes, such as the risk of becoming diseased or dying, are closely tied to socioeconomic status. The aim of the current study was to investigate the impact of socioeconomic status on morbidity, hospitalization, and mortality outcomes throughout five waves of the pandemic amongst the Israeli population. A retrospective archive study was conducted in Israel from March 2020 to February 2022 in which data were obtained from the Israeli Ministry of Health’s (MOH) open COVID-19 database. Our findings, though requiring careful and cautious interpretation, indicate that the socioeconomic gradient patterns established in previous COVID-19 literature are not applicable to Israel throughout the five waves of the pandemic. The conclusions of this study indicate a much more dynamic and complex picture, where there is no single group that dominates the realm of improved outcomes or bears the burden of disease with respect to morbidity, hospitalization, and mortality. We show that health trends cannot necessarily be generalized to all countries and are very much dynamic and contingent on the socio-geographical context and must be thoroughly examined throughout distinct communities with consideration of the specific characteristics of the disease. Furthermore, the implications of this study include the importance of identifying the dynamic interplay and interactions of sociodemographic characteristics and health behavior in order to enhance efforts toward achieving improved health outcomes by policymakers and researchers.
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20
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Hertz-Palmor N, Ruppin S, Matalon N, Mosheva M, Dorman-Ilan S, Serur Y, Avinir A, Mekori-Domachevsky E, Hasson-Ohayon I, Gross R, Gothelf D, Pessach IM. A 16-month longitudinal investigation of risk and protective factors for mental health outcomes throughout three national lockdowns and a mass vaccination campaign: Evidence from a weighted Israeli sample during COVID-19. Psychiatry Res 2023; 323:115119. [PMID: 36881950 PMCID: PMC9968478 DOI: 10.1016/j.psychres.2023.115119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND COVID-19 is an ongoing global crisis, with a multitude of factors that affect mental health worldwide. We explored potential predictors for the emergence and maintenance of depression, anxiety, and posttraumatic stress symptoms (PTSS) in the general population in Israel. METHODS Across the span of 16 months, 2478 people completed a repeated self-report survey which inquired psychiatric symptoms and pandemic related stress factors (PRSF). We applied mixed-effects models to assess how each stressor contributes to depression, anxiety and PTSS at each time point, and longitudinally assessed participants who completed at least two consecutive surveys (n = 400). We weighted our sample to increase representativeness of the population. RESULTS Fatigue was the strongest predictor for depression, anxiety and PTSS at all time points, and predicted deterioration overtime. Financial concerns associated with depression and anxiety at all time points, and with their deterioration overtime. Health related concerns were uniquely associated with anxiety and PTSS at all time points and their deterioration, but not with depression. Improvement in sense of protection overtime associated with decrease in depression and anxiety. Hesitancy towards vaccination was associated to higher financial concerns and lower sense of protection by the authorities. CONCLUSIONS Our findings accentuate the multitude of risk factors for psychiatric morbidity during COVID-19, and the centrality of fatigue in determining mental health outcomes.
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Affiliation(s)
- Nimrod Hertz-Palmor
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK; School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Israel.
| | - Shachar Ruppin
- School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Israel
| | - Noam Matalon
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Mariela Mosheva
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shirel Dorman-Ilan
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel
| | - Yaffa Serur
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel
| | - Asia Avinir
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel
| | - Ehud Mekori-Domachevsky
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Raz Gross
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Doron Gothelf
- The Child and Adolescent Psychiatry Division, Edmond and Lily Safra Children Hospital at Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Itai M Pessach
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Pediatric Intensive Care Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
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Sharman Moser S, Tanser F, Siegelmann-Danieli N, Apter L, Chodick G, Solomon J. The reimbursement process in three national healthcare systems: variation in time to reimbursement of pembrolizumab for metastatic non-small cell lung cancer. J Pharm Policy Pract 2023; 16:22. [PMID: 36797806 PMCID: PMC9936745 DOI: 10.1186/s40545-023-00529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
In this article, we focus on the reimbursement process, and as an example, characterize the time to reimbursement of pembrolizumab, a PD-1 immune checkpoint inhibitor for treatment of metastatic NSCLC from publicly available websites, in three different healthcare systems: The National Institute for Health and Care Excellence (NICE) in the UK, the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia, and the National Advisory Committee for the Basket of Health Services in Israel, all who have publicly funded health systems which include drug coverage. Our study found that there are substantial differences in time to reimbursement of pembrolizumab for the same conditions in different countries, with NICE and The National Advisory Committee for the Basket of Health Services in Israel approving one condition at the same time, Israel approving two conditions earlier than NICE, and PBAC lagging behind for every condition. These differences could be due to the differences in health policy systems and the many factors that affect reimbursement. Comparing the reimbursement process between different countries can highlight the challenges facing their health systems in early adoption of new treatments.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, 27 Hamered St, 6812509, Tel Aviv, Israel.
| | - Frank Tanser
- grid.36511.300000 0004 0420 4262Lincoln International Institute of Rural Health, Lincoln Medical School, University of Lincoln, Brayford Way, Brayford Pool, Lincoln, LN6 7TS UK
| | - Nava Siegelmann-Danieli
- grid.425380.8Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, 27 Hamered St, 6812509 Tel Aviv, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Apter
- grid.425380.8Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, 27 Hamered St, 6812509 Tel Aviv, Israel ,grid.7489.20000 0004 1937 0511Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gabriel Chodick
- grid.425380.8Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, 27 Hamered St, 6812509 Tel Aviv, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Josie Solomon
- grid.36511.300000 0004 0420 4262The School of Pharmacy, Joseph Banks Laboratories, University of Lincoln, Beevor Street, Lincoln, LN6 7DL UK
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22
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Bilu Y, Flaks-Manov N, Bivas-Benita M, Akiva P, Kalkstein N, Yehezkelli Y, Mizrahi-Reuveni M, Ekka-Zohar A, Shapiro Ben David S, Lerner U, Bodenheimer G, Greenfeld S. Data-Driven Assessment of Adolescents' Mental Health During the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)00053-9. [PMID: 36764609 PMCID: PMC9904823 DOI: 10.1016/j.jaac.2022.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Adolescents' mental health was severely compromised during the COVID-19 pandemic. Longitudinal real-world studies on changes in the mental health of adolescents during the later phase of the pandemic are limited. We aimed to quantify the effect of COVID-19 pandemic on adolescents' mental health outcomes based on electronic health records. METHOD This was a retrospective cohort study using the computerized database of a 2.5 million members, state-mandated health organization in Israel. Rates of mental health diagnoses and psychiatric drug dispensations were measured among adolescents 12 to 17 years of age with and without pre-existing mental history, for the years 2017 to 2021. Relative risks were computed between the years, and interrupted time series (ITS) analyses evaluated changes in monthly incidence rates of psychiatric outcomes. RESULTS The average population size was 218,146 in 2021. During the COVID-19 period, a 36% increase was observed in the incidence of depression (95% CI = 25-47), 31% in anxiety (95% CI = 23-39), 20% in stress (95% CI = 13-27), 50% in eating disorders (95% CI = 35-67), 25% in antidepressant use (95% CI = 25-33), and 28% in antipsychotic use (95% CI = 18-40). A decreased rate of 26% (95% CI = 0.80-0.88) was observed in ADHD diagnoses. The increase of the examined outcomes was most prominent among youth without psychiatric history, female youth, general secular Jewish population, youth with medium-high socioeconomic status, and those 14 to 15 years of age. ITS analysis confirmed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to those in previous years. CONCLUSION This real-world study highlights the deterioration of adolescents' mental health during the COVID-19 pandemic and suggests that youth mental health should be considered during health policy decision making. DIVERSITY & INCLUSION STATEMENT We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
| | | | | | | | | | - Yoav Yehezkelli
- KI Research Institute, Kfar-Malal, Israel; Maccabi Healthcare Services, Tel-Aviv, Israel
| | | | | | | | - Uri Lerner
- Maccabi Healthcare Services, Tel-Aviv, Israel
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23
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Ramot S, Tal O. Attitudes of Healthcare Workers in Israel towards the Fourth Dose of COVID-19 Vaccine. Vaccines (Basel) 2023; 11:vaccines11020385. [PMID: 36851263 PMCID: PMC9966952 DOI: 10.3390/vaccines11020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/10/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Attitudes of healthcare workers (HCWs) toward vaccines are extremely important for increasing vaccination coverage. We conducted a cross-sectional study at the beginning of the fourth COVID-19 vaccination dose campaign among 124 HCWs to evaluate attitudes towards the fourth dose and willingness to get vaccinated. At that time, Israel was the first country to approve the fourth vaccine dose. Most women were unwilling to get the fourth vaccine dose compared to men; 53.9% of physicians were unwilling to get vaccinated compared to 83.3% of nurses and 69% of other HCWs professions. The most frequent concerns regarding the vaccine were its efficacy, benefit, and necessity. The perceived risk and perceived severity of the health risk involved with getting vaccinated with the fourth dose were higher among HCWs who stated that they would not get vaccinated compared to those who were vaccinated or intended to get vaccinated. In contrast, HCWs who were vaccinated with the fourth dose, or those who were planning to get vaccinated, gave higher scores to the perceived benefit of the booster, its advantages, its perceived safety, its ability to protect from severe illness, and the perceived extent of scientific information about the risk associated with the booster. A logistic regression model revealed that perception of the fourth dose's benefits and risk significantly predict the willingness of HCWs to get vaccinated. Willingness to vaccinate their own children, acceptance of a hypothetical annual booster vaccine, and having less severe adverse effects after prior vaccination were also associated with willingness to get the fourth dose. These findings could help policy makers in developing strategies to expand the acceptance and coverage of the COVID-19 booster doses.
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Affiliation(s)
- Shira Ramot
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan 5290002, Israel
- Correspondence:
| | - Orna Tal
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan 5290002, Israel
- Shamir Medical Center (Assaf Harofeh), Zerifin 7033001, Israel
- ICET—Israeli Center for Emerging Technologies, Zerifin 7033001, Israel
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24
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Thelen ST, Yoo B. The impact of country image and patient cosmopolitanism on medical tourism. Health Mark Q 2023; 40:98-118. [PMID: 36651293 DOI: 10.1080/07359683.2023.2167260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this research is to examine the impact affective/cognitive country image, cosmopolitanism, and satisfaction with insurance have on patient willingness to go abroad for surgery. Patients are presented a scenario where they select having knee replacement surgery domestically, having to pay all co-pays and deductibles, or abroad (Mexico, India, Israel) for free surgery at a JCI certified hospital. Results indicate cosmopolitanism impacts patient perception of medical tourism whilst affective and cognitive country image exhibit varying levels of significance. This study contributes to the literature by assessing factors that impact patient likelihood to travel abroad for surgery.
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Affiliation(s)
- Shawn T Thelen
- Department of Marketing and International Business, Frank G. Zarb School of Business, Hofstra University, Hempstead, NY, USA
| | - Boonghee Yoo
- Department of Marketing and International Business, Frank G. Zarb School of Business, Hofstra University, Hempstead, NY, USA
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25
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Tanous O, Asi Y, Hammoudeh W, Mills D, Wispelwey B. Structural racism and the health of Palestinian citizens of Israel. Glob Public Health 2023; 18:2214608. [PMID: 37209155 DOI: 10.1080/17441692.2023.2214608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 05/11/2023] [Indexed: 05/22/2023]
Abstract
Palestinian citizens of Israel (PCI) constitute almost 20% of the Israeli population. Despite having access to one of the most efficient healthcare systems in the world, PCI have shorter life expectancy and significantly worse health outcomes compared to the Jewish Israeli population. While several studies have analysed the social and policy determinants driving these health inequities, direct discussion of structural racism as their overarching etiology has been limited. This article situates the social determinants of health of PCI and their health outcomes as stemming from settler colonialism and resultant structural racism by exploring how Palestinians came to be a racialized minority in their homeland. In utilising critical race theory and a settler colonial analysis, we provide a structural and historically responsible reading of the health of PCI and suggest that dismantling legally codified racial discrimination is the first step to achieving health equity.
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Affiliation(s)
- Osama Tanous
- FXB Center for Health and Human Rights at Harvard University, Boston, MA, USA
| | - Yara Asi
- FXB Center for Health and Human Rights at Harvard University, Boston, MA, USA
| | - Weeam Hammoudeh
- FXB Center for Health and Human Rights at Harvard University, Boston, MA, USA
| | - David Mills
- FXB Center for Health and Human Rights at Harvard University, Boston, MA, USA
| | - Bram Wispelwey
- FXB Center for Health and Human Rights at Harvard University, Boston, MA, USA
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26
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Trends and Correlates of Early-Life Exposure to Acid-Suppressant Therapy in Israel (2005-2020). J Pediatr 2023; 252:141-145.e1. [PMID: 36027979 DOI: 10.1016/j.jpeds.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/30/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe trends and correlates of acid-suppressant therapy usage during the first year of life. STUDY DESIGN A population-based cohort in a large state-mandated health fund in Israel, including members born between 2005 and 2020, was conducted. Acid-suppressant therapy initiation was defined by any purchase within the first year of life. The association between acid-suppressant therapy initiation with medical and sociodemographic characteristics was assessed via logistic regression. RESULTS Among 595 860 children, acid-suppressant therapy was initiated in 22 412 (37.6 per 1000). The incidence rate increased by 2.8-fold from 18.2 per 1000 in 2005 to 51.0 per 1000 in 2020, furthermore the median age at initiation decreased. Primary care providers accounted for 74.8% of prescribing physicians in 2005 vs 96.1% in 2020, whereas the prevalence of prescribing gastroenterologists decreased from 18.8% to 2.8%. Preterm birth and small weight per gestational age were associated with acid-suppressant therapy usage, with an aOR of 4.23 (95% CI 3.59-4.99), 3.05 (95% CI 2.72-3.42), and 1.65 (95% CI 1.58-1.74) for extreme, very, and moderate preterm vs term birth and aOR 1.22 (95% CI 1.16-1.28) for small weight per gestational age. Birth order was inversely associated with acid-suppressant therapy initiation, with aOR 0.62 (95% CI 0.60-0.65) for third born vs firstborns. High socioeconomic status was linearly associated with initiation, with aOR 1.12 (95% CI 1.11-1.12) per 1-point increase on a 10-point score. CONCLUSIONS Our analysis demonstrates a substantial increase in early life exposure to acid-suppressant therapy during recent years in Israel. Correlates for initiation in early life were identified to define a population for intervention to reduce potential unnecessary use.
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27
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Moshel S, Klang S, Nikname R, Bar Shalom K, Albukrek D, Zacay G. Automated versus manual prior authorization for diabetes mellitus drugs: A retrospective study from Israel. Digit Health 2023; 9:20552076231203889. [PMID: 37780061 PMCID: PMC10540583 DOI: 10.1177/20552076231203889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Drug prior authorization (PA) imposes a bureaucratic and economic burden on healthcare service providers and payers. A novel automated PA system may improve these drawbacks. Methods An historical cohort study from a large health maintenance organization in Israel, comparing manual versus automated PA mechanisms for diabetes mellitus (DM) drugs: sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 analogs (GLP1-A). We compared patients with DM, whose first drug applications were approved using the automated system, with similar patients whose first drug applications were approved by manual PA. The primary endpoint was the time elapsed from application approval to prescription filling (accessibility time). Secondary endpoints included the prescription filling rate at 7 and 30 days. Results In total, 1371 automated approved prescriptions and 1240 manually approved prescriptions were included in the analysis. Median accessibility time was one day (interquartile range (IQR) 0-5) with automated PA for both GLP1-A and SGLT2i, compared with four days (IQR 1-9) and three days (IQR 1-8), respectively, with the manual PA (p < 0.001). Eighty-four percent of GLP1-A automated PA approvals were filled within seven days compared with 70% with manual PA (p < 0.001). Similar results were seen with SGLT2i (80% vs. 72%, p < 0.008). No differences were observed at 30 days post-approval. Using logistic regression, odds for GLP1-A and SGLT2i prescription filling within seven days were 2.36 and 1.53 folds higher (respectively) with automated PA (p < 0.01). Conclusions Automated PA system improved access time to SGLT2i/GLP1-A seven days post-approval compared to manual PA.
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Affiliation(s)
- Shai Moshel
- Meuhedet Health Services, Tel Aviv, Israel
- Department of Health System Management, Peres Academic Center, Rehovot, Israel
| | - Shmeul Klang
- School of Public Health, University of Haifa, Haifa, Israel
| | | | | | | | - Galia Zacay
- Meuhedet Health Services, Tel Aviv, Israel
- Department of Family Medicine, Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
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28
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Akinwumi AI, OlaOlorun AD, Adesina SA, Durodola AO, Amole IO, Singer SR, Levine H. Strong primary care services, an important feature of primary health care: What can Nigeria learn from Israel? Front Public Health 2022; 10:1006095. [PMID: 36589941 PMCID: PMC9801635 DOI: 10.3389/fpubh.2022.1006095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Akinsola Idowu Akinwumi
- Department of Family Medicine, Afe Babalola University, Ado Ekiti, Nigeria,Department of Family Medicine, ABUAD Multi-System Hospital, Ado Ekiti, Ekiti, Nigeria,*Correspondence: Akinsola Idowu Akinwumi ; ;
| | - Akintayo David OlaOlorun
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Stephen Adesope Adesina
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Adewumi Ojeniyi Durodola
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Isaac Olusayo Amole
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Shepherd Roee Singer
- Hadassah Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel,Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Hagai Levine
- Hadassah Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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29
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Abstract
BACKGROUND One Digital Health (ODH) aims to propose a framework that merges One Health's and Digital Health's specific features into an innovative landscape. FAIR (Findable, Accessible, Interoperable, and Reusable) principles consider applications and computational agents (or, in other terms, data, metadata, and infrastructures) as stakeholders with the capacity to find, access, interoperate, and reuse data with none or minimal human intervention. OBJECTIVES This paper aims to elicit how the ODH framework is compliant with FAIR principles and metrics, providing some thinking guide to investigate and define whether adapted metrics need to be figured out for an effective ODH Intervention setup. METHODS An integrative analysis of the literature was conducted to extract instances of the need-or of the eventual already existing deployment-of FAIR principles, for each of the three layers (keys, perspectives and dimensions) of the ODH framework. The scope was to assess the extent of scatteredness in pursuing the many facets of FAIRness, descending from the lack of a unifying and balanced framework. RESULTS A first attempt to interpret the different technological components existing in the different layers of the ODH framework, in the light of the FAIR principles, was conducted. Although the mature and working examples of workflows for data FAIRification processes currently retrievable in the literature provided a robust ground to work on, a nonsuitable capacity to fully assess FAIR aspects for highly interconnected scenarios, which the ODH-based ones are, has emerged. Rooms for improvement are anyway possible to timely deal with all the underlying features of topics like the delivery of health care in a syndemic scenario, the digital transformation of human and animal health data, or the digital nature conservation through digital technology-based intervention. CONCLUSIONS ODH pillars account for the availability (findability, accessibility) of human, animal, and environmental data allowing a unified understanding of complex interactions (interoperability) over time (reusability). A vision of integration between these two worlds, under the vest of ODH Interventions featuring FAIRness characteristics, toward the development of a systemic lookup of health and ecology in a digitalized way, is therefore auspicable.
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Affiliation(s)
- Oscar Tamburis
- Institute of Biostructures and Bioimaging, National Research Council of Italy, Naples, Italy
| | - Arriel Benis
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon, Israel,Faculty of Digital Medical Technologies, Holon Institute of Technology, Holon, Israel,Address for correspondence Arriel Benis, PhD Faculty of Industrial Engineering and Technology Management, Holon Institute of TechnologyGolomb St 52, PoB 305, HolonIsrael
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30
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Shai O. Out of time? The effect of an infrequent traumatic event on individuals' time and risk preferences, beliefs, and insurance purchasing. JOURNAL OF HEALTH ECONOMICS 2022; 86:102678. [PMID: 36095896 DOI: 10.1016/j.jhealeco.2022.102678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 07/24/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
This study examines the effect on time preferences and the purchase of insurance by persons closely acquainted with someone who was in danger of physical injury (trauma) during Israel's military operation in the Gaza Strip in 2014. To this end, I use panel data to track the same individuals before and after the trauma. My results reveal that experiencing trauma increases individuals' purchases of insurance, and in particular supplementary health and long-term care insurance. Investigating the mechanisms behind the results, I find that people become more future-oriented after someone close to them was in danger of physical injury during that military operation. However, I cannot completely rule out other causes such as an increase in risk aversion or changes in individuals' beliefs.
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Affiliation(s)
- Ori Shai
- University of Haifa, Department of Economics, 199 Aba Khoushy Ave. Mount Carmel, Haifa, Israel.
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31
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Kaufman-Shriqui V, Shani M, Boaz M, Lahad A, Vinker S, Birk R. Opportunities and challenges in delivering remote primary care during the Coronavirus outbreak. BMC PRIMARY CARE 2022; 23:135. [PMID: 35641930 PMCID: PMC9151999 DOI: 10.1186/s12875-022-01750-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/25/2022] [Indexed: 11/18/2022]
Abstract
Background Social distancing and lockdowns were implemented during the first period of the COVID-19 pandemic. Primary care physicians needed to adapt quickly to deliver remote care/telemedicine. Methods A cross-sectional, 47-item online Google Survey was distributed through the Israel Association of Family Physicians (IAFP) mailing list between March 31-May 5, 2020. The questionnaire included demographics, physician characteristics, and information on usage and perceived telemedicine quality. Sampling weights by sex and age groups were applied. Results One hundred fifty-nine primary care physicians (10.6% of registered IAFP members; 63.5% women; mean age 53.4 ± 10.4 years and median professional experience 21.3 years) replied to the survey. The majority (59.7%) of the participants performed a mixture of in-person along with phone counseling. About 40% had no former telemedicine experience. The majority indicated that telephone and video formats were inferior to in-person consultation (68%, 57.1% online and phone, respectively). The overall counseling quality grade (on a 1–10 scale,)median (IQR)) was 6.2 (3) for telephone and 7(2) for video. While 66.9% reported experiencing no challenges, 10% had technical problems, 10% interpersonal problems, 5.6% scheduling difficulties, and 7.5% other difficulties. Majority of 56.6% physicians indicated they prescribed more antibiotics,16.4% sent more blood tests, 24.5% referred more to experts, and 49.7% referred more to imaging in comparison to usual counseling. Higher phone quality score was significantly associated with physicians who indicated not prescribing more antibiotics during the pandemic (OR = 0.30, 95%CI 0.134–0.688, p = 0.004). Higher online quality score was associated with physicians who indicated not sending more blood tests during the pandemic (OR = 0.06 95%CI 0.008–0.378, P = 0.003). Conclusions Our findings suggest telehealth holds considerable promise for counseling in the primary care setting. However, interpersonal challenges raised by physicians should be understood in-depth to develop tailored training and further examine it in randomized trials while integrating patient-reported outcomes. Finally, further research on utility, cost, and cost-efficiency during remote counseling with follow-ups, medical prescribing, and additional referrals is needed.
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32
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Ramot S, Tal O. Attitudes of healthcare workers and members of the public toward the COVID-19 vaccine: A cross-sectional survey. Hum Vaccin Immunother 2022; 18:2124782. [PMID: 36314896 PMCID: PMC9746361 DOI: 10.1080/21645515.2022.2124782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022] Open
Abstract
The COVID-19 pandemic has led to the rapid development and implementation of vaccines. However, uncertainty about their safety and effectiveness among some people has led to vaccine hesitancy. We conducted a cross-sectional survey in March 2021 among individuals from the general Israeli population and health-care workers (HCWs) to examine risk perception toward the COVID-19 vaccine, trust in health-care providers and information sources used for making health-related decisions. The study population included 739 respondents: 42.6% HCWs and 57.4% members of the public. Participants' perceived risk toward the vaccine was relatively low in both populations. Higher perceived benefit of the vaccine, higher perceived extent of knowledge that doctors have about the risk associated with the vaccine, higher perceived freedom to choose whether to get vaccinated and higher trust in health-care providers predicted lower perceived risk toward the vaccine. Individuals who showed greater health responsibility, those who usually get vaccinated against influenza and those who had greater objective knowledge on the COVID-19 vaccine demonstrated lower perceived risk. No statistically significant difference in trust level was found between HCWs and members of the public. Both populations regarded information from medical sources as their greatest influence on health-related decisions. The study points to the factors influencing the perceived risk toward the COVID-19 vaccine and emphasizes the unique status of HCWs having their own views and concerns about the vaccine as individual members. Policymakers should consider these factors when planning national vaccination campaigns.
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Affiliation(s)
- Shira Ramot
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel
| | - Orna Tal
- Department of Management, Health Systems Management Program, Bar Ilan University, Ramat Gan, Israel
- Shamir Medical Center (Assaf Harofeh), Be’er Ya’akov, Israel
- ICET - Israeli Center for Emerging Technologies, Shamir Medical center, Be’er Ya’akov, Israel
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Unger S, Orr Z, Alpert EA, Davidovitch N, Shoham-Vardi I. Social and structural determinants of emergency department use among Arab and Jewish patients in Jerusalem. Int J Equity Health 2022; 21:156. [DOI: 10.1186/s12939-022-01698-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/02/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
A growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance.
Methods
A cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days.
Results
There were differences between Jewish and Arab patients’ social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty.
Conclusion
The study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.
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Gunshot casualties in Israel: A decade of violence. Injury 2022; 53:3156-3162. [PMID: 35985856 DOI: 10.1016/j.injury.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to identify and characterize casualties hospitalized with assault (non-terror) related gunshot wounds (GSW) in Israel as a basis for determining the incidence, trends and at-risk population groups. METHODS This retrospective cohort study is based on data from the Israel National Trauma Registry. The data includes GSW casualties hospitalized between January 1, 2011 and December 31, 2020. Attempted suicide, unintentional injury, legal intervention, children (ages 0-9) and terror (Israeli-Arab conflict) related GSW were excluded. The remaining population was classified with an ICD-9-CM diagnosis code of 965.0-965.4. RESULTS The study population included 2,763 GSW admissions. A noticeable increase in GSW casualties was reported, from 206 hospitalization in 2011 to 456 in 2020. The proportion of Arab casualties increased from 73.3% of all GSW casualties in 2011 to 90.8% in 2020, far more than their proportion in the population (∼20%). The majority of the GSW casualties were males (95.8%) and between the ages of 20 and 29 (42.2%). Among severe/critical casualties, 19% of Arabs and 9.9% of Jews arrived by private car. Severe thoracic and abdominal injuries were the prominent injuries among fatal casualties (47.6 and 40.8, respectively). While the all-severity mortality rate was 5.6% (n = 147), 24.4% (n = 135) of severe/critical (ISS16+) casualties died, with no significant differences between Jews and Arabs. Forty percent of deaths occurred in the emergency department. CONCLUSIONS This study establishes that during the past decade in Israel, not only has there been a continuous increase in hospitalizations due to GSW, but also Arabs are at great risk of such related hospitalizations. Preventive strategies targeting at-risk groups are crucial for minimizing morbidity and mortality related to GSW in Israel.
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Blitman E, Biderman A, Yehoshua I, Adler L. Breastfeeding mothers' experiences with community physicians in Israel: a qualitative study. Int Breastfeed J 2022; 17:62. [PMID: 36042492 PMCID: PMC9425787 DOI: 10.1186/s13006-022-00506-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The guidelines of all leading professional organizations recommend providing adequate support and education regarding breastfeeding; yet many mothers feel that they receive inadequate information from their health care providers in the primary care setting. This is in line with studies that demonstrate that physicians' knowledge about breastfeeding is lacking. The aim of this study was to expand our understanding of the breastfeeding-related experiences of mothers with primary care physicians (PCPs). METHODS In this qualitative study, we interviewed breastfeeding mothers in Israel in the first six months after delivery. The interviews were conducted between December 2020 and May 2021. We used thematic analysis to explore women's attitudes and experiences with their PCPs regarding breastfeeding concerns. All authors read the transcribed interviews and independently marked statements regarding breastfeeding. Then, in a joint process, codes, subthemes and themes were defined. Each subtheme was backed up with a quote from the interviews. RESULTS We interviewed 13 women aged 24 to 37. We identified four main themes. The first of these was physicians' inconsistent attitudes toward breastfeeding. Some were indifferent, while others related to breastfeeding solely in the context of infant development. Some were supportive, while others opposed breastfeeding. Several women revealed physicians' inappropriate and disturbing attitudes to breastfeeding. The second theme was physicians' lack of knowledge regarding medical treatment for breastfeeding issues. This theme included lack of knowledge, incorrect treatment of breastfeeding problems, and contradictions among HCPs. The third was mothers' preference for alternative resources, including individualized breastfeeding counselling, maternity and childcare nurses, mothers' groups (in person or online), and family and friends over medical treatment for breastfeeding problems. The fourth theme involved mothers' suggestions for PCPs, which highlighted the importance of communication, prenatal physician-initiated dialogue on breastfeeding, expanding professional knowledge on breastfeeding, and increasing the availability of treatment for breastfeeding problems. CONCLUSION The women in this study reported unsatisfactory breastfeeding support by PCPs and incorrect or inadequate treatment of medical problems related to breastfeeding. They also felt they had no medical experts to approach with breastfeeding-related problems. We believe that physicians should expand their knowledge on breastfeeding medicine so that they can provide comprehensive patient-centered treatment to both mothers and infants. Education programs for improving knowledge and skills in breastfeeding issues should be implemented throughout the medical training.
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Affiliation(s)
- Elia Blitman
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aya Biderman
- Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clalit Health Services, Southern District, Beer-Sheva, Israel
| | - Ilan Yehoshua
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Limor Adler
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv, Israel. .,Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sela Y, Artom T, Rosen B, Nissanholtz-Gannot R. Primary Care Physicians' Perceptions on Nurses' Shared Responsibility for Quality of Patient Care: A Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10730. [PMID: 36078444 PMCID: PMC9518020 DOI: 10.3390/ijerph191710730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Nurses are key players in primary care in Israel and in the efforts to improve its quality, yet a survey conducted among primary care physicians (PCPs) in 2010 indicated that 40% perceived the contribution of nurses to primary care quality as moderate to very small. In 2020, we conducted a cross-sectional survey using self-report questionnaires among PCPs employed by health plans to examine the change in PCPs' perceptions on nurses' responsibility and contributions to quality of primary care between 2010 and 2020. Four-hundred-and-fifty respondents completed the questionnaire in 2020, as compared to 605 respondents in 2010. The proportion of PCPs who perceive that nurses share the responsibility for improving the quality of medical care increased from 74% in 2010 to 83% in 2020 (p < 0.01). Older age, males, self-employment status, and board certification in family medicine independently predicted reduced PCP perception regarding nurses' responsibility for quality-of-care. PCPs who believed that nurses contribute to quality of practice were 7.2 times more likely to perceive that nurses share the responsibility for quality-of-care. The study showed that over the past decade there was an increase in the extent to which PCPs perceive nurses as significant partners in improving quality of primary care.
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Affiliation(s)
- Yael Sela
- Nursing Science Department, Faculty of Social and Community Sciences, Ruppin Academic Center, Emeq-Hefer 4025000, Israel
| | - Tamar Artom
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem 9103702, Israel
| | - Bruce Rosen
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem 9103702, Israel
| | - Rachel Nissanholtz-Gannot
- Department of Health Systems Management, School of Health Sciences, Ariel University, Ariel 4076414, Israel
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Epidemiology of Progressive Supranuclear Palsy: Real World Data from the Second Largest Health Plan in Israel. Brain Sci 2022; 12:brainsci12091126. [PMID: 36138862 PMCID: PMC9496895 DOI: 10.3390/brainsci12091126] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022] Open
Abstract
Progressive supranuclear palsy (PSP) is a rare and fatal neurodegenerative movement disorder and no disease modifying therapy (DMT) is currently available. This study aims to assess the epidemiology of PSP in Israel and to describe its clinical features. This retrospective analysis identified patients with PSP between 2000 and 2018 over the age of 40 years at first diagnosis (index date). We identified 209 patients with ≥1 diagnosis of PSP. Of those, 88 patients satisfied the inclusion criteria with a mean age at diagnosis of 72 years (SD = 8) and 53% were female. The 2018 prevalence and incidence rates were 5.3 and 1 per 100,000 persons, respectively. Median survival time was 4.9 years (95% CI 3.6–6.1) and median time from initial symptom to diagnosis was 4.2 years. The most common misdiagnoses were Parkinson’s disease, cognitive disorder and depression. The present study demonstrates that the clinic-epidemiological features of PSP in Israel are similar to PSP worldwide. In light of PSP’s rarity, investigation of PSP cohorts in different countries may create a proper platform for upcoming DMT trials.
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Wilf-Miron R, Avni S, Valinsky L, Myers V, Ziv A, Peretz G, Luxenburg O, Saban M, Feder-Bubis P. Developing a National Set of Health Equity Indicators Using a Consensus Building Process. Int J Health Policy Manag 2022; 11:1522-1532. [PMID: 34273926 PMCID: PMC9808363 DOI: 10.34172/ijhpm.2021.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Considerable health inequities documented in Israel between communities, populations and regions, undermine the rights of all citizens to optimal health. The first step towards health equity is agreement on a set of national indicators, reflecting equity in healthcare provision and health outcomes, and allowing monitoring of the impact of interventions on the reduction of disparities. We describe the process of reaching a consensus on a defined set of national equity indicators. METHODS The study was conducted between January 2019 and June 2020, in a multistage design: (A) Identifying appropriate and available inequity measures via interviews with stakeholders. (B) Agreement on the screening criteria (public health importance; gap characteristics; potential for change; public interest) and relative weighting. (C) Constructing the consultation framework as an online, 3-round Delphi technique, with a range of experts recruited from the health, welfare and education sectors. RESULTS Participants were of diverse age, gender, geographic location, religion and ethnicity, and came from academia, healthcare provision, government ministries and patient representative groups. Thirty measures of inequity, presented to participants, represented the following domains: Health promotion (11 indicators), acute and chronic morbidity (11), life expectancy and mortality (2), health infrastructures and affordability of care (4), education and employment (2). Of the 77 individuals contacted, 75 (97%) expressed willingness to participate, and 55 (73%) completed all three scoring rounds. The leading ten indicators were: Diabetes care, childhood obesity, adult obesity, distribution of healthcare personnel, fatal childhood injuries, cigarette smoking, infant mortality, ability to afford care, access to psychotherapy and distribution of hospital beds. Agreement among raters, measured as intra-class correlation coefficient (ICC), was 0.75. CONCLUSION A diverse range of consultants reached a consensus on the most important national equity indicators, including both clinical and system indicators. Results should be used to guide governmental decision-making and inter-sectoral strategies, furthering the pursuit of a more equitable healthcare system.
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Affiliation(s)
- Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Avni
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - Liora Valinsky
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Arnona Ziv
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Gidi Peretz
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences & Guildford Glazer Faculty of Business and management, Ben Gurion University of the Negev, Beersheba, Israel
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Barer Y, Chodick G, Glaser Chodick N, Gurevich T. Risk of Parkinson Disease Among Adults With vs Without Posttraumatic Stress Disorder. JAMA Netw Open 2022; 5:e2225445. [PMID: 35925604 PMCID: PMC9353613 DOI: 10.1001/jamanetworkopen.2022.25445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) in elderly men may be associated with increased risk of Parkinson disease (PD); thus, this group of patients needs to be monitored closely for timely, customized treatment. OBJECTIVE To evaluate the risk of PD in patients with PTSD compared with patients without PTSD. DESIGN, SETTING, AND PARTICIPANTS This population-based, retrospective, cohort study used data from Maccabi Health Care Services (MHS), the second largest health plan in Israel, spanning from 2000 to 2019. Participants included MHS members born before 1970 who received a diagnosis of PTSD in 2000 to 2015. Patients with PTSD who had PD before their first diagnosis were excluded. Data analysis was performed from February to June 2022. EXPOSURES Incident PTSD was denoted by at least 1 diagnosis (1) given by psychiatrists, psychologists, or neurologists; (2) hospital discharge diagnosis; or (3) registered as a chronic diagnosis (defined as such by the primary care physician). The index date was defined as first diagnosis for the patients with PTSD and for the corresponding patients without PTSD. MAIN OUTCOMES AND MEASURES PD incident cases up to 2019 were ascertained by idiopathic PD diagnosis (1) given by a neurologist, (2) extracted from a hospital discharge report, or (3) registered as a chronic diagnosis. Patients with PD-like syndromes documentation after the last mention of PD were excluded. RESULTS Of 8342 eligible patients, 8336 (99.9%) were matched to nonexposed patients in a 1:1 ratio by birth year and sex; 4303 patients (51.6%) were male, and the mean (SD) age at index was 55.8 (13.2) years. Patients with PTSD had a 1.48-fold (95% CI, 1.10-1.99) excess risk for PD, compared with patients without PTSD. An elevated risk of PD (hazard ratio, 1.95; 95% CI, 1.16-3.28) was recorded among men receiving a diagnosis of PTSD at age 72 years or older. CONCLUSIONS AND RELEVANCE These findings suggest that elderly men who receive a diagnosis of PTSD are at an increased risk of PD. Further studies are needed to corroborate these findings and to further assess the association of stress with PD risk.
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Affiliation(s)
- Yael Barer
- Maccabitech, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tanya Gurevich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Gabay G, Ben-Asher S. An Inverted Container in Containing and Not Containing Hospitalized Patients—A Multidisciplinary Narrative Inquiry. Front Public Health 2022; 10:919516. [PMID: 35875012 PMCID: PMC9304809 DOI: 10.3389/fpubh.2022.919516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivePatient-centered care calls to contain patients in their time of crisis. This study extends the knowledge of provider patient interactions in the hectic environment of acute care applying Bion's container-contained framework from psychoanalysis.MethodsFollowing ethical approval, we performed a narrative inquiry of the experiences of ten patients upon discharge from lengthy hospitalizations in acute care. Interviews were conducted upon discharge and about one-month post-discharge.FindingsData analysis suggests four modes of containing of patients by providers. In nurturing interactions, typical of an active container-contained mode, patients experienced humanized care, symptom control, hope, and internal locus of control. This mode yielded patient gratitude toward providers, wellbeing, and post-discharge self-management of diseases. In rigid and wall-free modes of containing, patients experienced a sense of powerlessness and discomfort. A new mode of container-contained was identified, the “Inverted Container”, which extends Bion's theory and contradicts patient-centered care. In inverted containers, patients contained the providers yet reported feeling gratitude toward providers. The gratitude constitutes a defense mechanism and reflects a traumatic experience during hospitalization, which led to post-discharge distrust in providers and hospitals and poor self-management of illness.ConclusionsTo effectively provide patient-centered care, provider-patient interaction in lengthy hospitalizations must move along a clinical axis and a relationship axis. This shifting may facilitate containing patients in their time of crisis so essential processes of reflection, projection, and transference are facilitated in-hospital care.
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Affiliation(s)
- Gillie Gabay
- Multi-Disciplinary Studies, Achva Academic College, Shikmim, Israel
- *Correspondence: Gillie Gabay
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Corry L. [Israel and covid-19: how will the history of the epidemic in this country be written in the future?]. HISTORIA, CIENCIAS, SAUDE--MANGUINHOS 2022; 29:751-761. [PMID: 36074360 DOI: 10.1590/s0104-59702022000300009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/04/2021] [Indexed: 06/15/2023]
Abstract
This article attempts to hypothetically reflect on how historians of science will write their research on the development of the covid-19 pandemic in Israel in the future, within a context that includes: the political crisis experienced by the country at that time; the history of the public health institutions established from the time of the first Jewish settlers in Palestine, at the beginning of the twentieth century, and slightly modified by a law of 1994; the conceptual schemes developed during the last decades by historians of public health and pandemics in general.
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Affiliation(s)
- Leo Corry
- Profesor, Cohn Institute for History and Philosophy of Science / Tel Aviv University . Tel Aviv - Israel
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Graucher T, Sinai-Gavrilov Y, Mor Y, Netzer S, Cohen EY, Levi L, Avtalion TB, Koller J. From Clinic Room to Zoom: Delivery of an Evidence-Based, Parent-mediated Intervention in the Community Before and During the Pandemic. J Autism Dev Disord 2022; 52:5222-5231. [PMID: 35764769 PMCID: PMC9244456 DOI: 10.1007/s10803-022-05592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
Disruptive behaviors (DBs) are common in children with autism, affecting child and family quality of life. Parent-mediated interventions (PMIs) are a cost-effective and accessible way to decrease DBs. COVID-19 increased need for telehealth interventions. This study explored a group delivery of an evidence-based PMI (RUBI), delivered face-to-face and virtually in Israel, before and during the pandemic. Fifty-five families of children with autism and DB participated, 24 receiving face-to-face intervention and 31 receiving virtual. Outcome measures included the Aberrant Behavior Checklist and Home Situations Questionnaires. Results indicate reduction of DBs across groups, with > 50% of treatment-responders showing reliable change. This study is the first to assess RUBI outside the US among a sociodemographically diverse population, in both in-person and virtual contexts.
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Affiliation(s)
- Tobi Graucher
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yana Sinai-Gavrilov
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yaniv Mor
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel.,The Open University, Ra'anana, Israel
| | - Shay Netzer
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Y Cohen
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Linoy Levi
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Judah Koller
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel.
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Orr Z, Jackson L, Alpert EA, Fleming MD. Neutrality, conflict, and structural determinants of health in a Jerusalem emergency department. Int J Equity Health 2022; 21:89. [PMID: 35751059 PMCID: PMC9233380 DOI: 10.1186/s12939-022-01681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on health inequity. This article analyzes how healthcare professionals understand and negotiate the depoliticized space of the emergency department (ED) through their views on neutrality. It also examines how medical staff use depoliticized concepts of culture to account for differences in the health status of patients from disadvantaged groups. These questions are examined in the context of the Israeli-Palestinian conflict. METHODS Twenty-four in-depth, semi-structured interviews were conducted with healthcare personnel in a Jerusalem hospital's ED. All but one of the participants were Jewish. The interviews were analyzed using qualitative content analysis and Grounded Theory. RESULTS The ED staff endorsed the perspective of medical neutrality as a nondiscriminatory approach to care. At the same time, some medical staff recognized the limits of medical neutrality in the context of the Israeli-Palestinian conflict and negotiated and challenged this concept. While participants identified unique health risks for Arab patients, they usually did not associate these risks with the effects of conflict and instead explained them in depoliticized terms of cultural and behavioral differences. Culture served as a non-controversial way of acknowledging and managing problems that have their roots in politics. CONCLUSIONS The normative demand for neutrality works to exclude discussion of the conflict from clinical spaces. The normative exclusion of politics is a vital but under-appreciated aspect of how political conflict operates as a structural determinant of health. Healthcare personnel, especially in the ED, should be trained in structural competency. This training may challenge the neglect of issues that need to be solved at the political level and enhance health equity, social justice, and solidarity.
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Affiliation(s)
- Zvika Orr
- Department of Nursing, Jerusalem College of Technology, 11 Beit Hadfus Street, Jerusalem, Israel.
| | - Levi Jackson
- Department of Nursing, Jerusalem College of Technology, 11 Beit Hadfus Street, Jerusalem, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center; Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Bait Street, Jerusalem, Israel
| | - Mark D Fleming
- School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, USA
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Du H, Shi Q, Song P, Pan XF, Yang X, Chen L, He Y, Zong G, Zhu Y, Su B, Li S. Global Burden Attributable to High Low-Density Lipoprotein-Cholesterol From 1990 to 2019. Front Cardiovasc Med 2022; 9:903126. [PMID: 35757342 PMCID: PMC9218272 DOI: 10.3389/fcvm.2022.903126] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/02/2022] [Indexed: 01/29/2023] Open
Abstract
Background High low-density lipoprotein-cholesterol (LDL-C) is a public health issue contributing to ischemic heart disease (IHD) and stroke. Method In this ecological study, we collected summary exposure values (SEVs), deaths, disability-adjusted life of years (DALYs), and Social Demographic Index (SDI) of high LDL-C from 1990 to 2019 using the query tool from the Global Burden of Disease (GBD) Collaborative Network. Outcomes include SEVs, deaths, and DALYs attributable to high LDL-C stratified by sex, age, region, SDI, countries, and territories. Estimated annual percentage changes (EAPCs) were applied to estimate annual trends of changes in these outcomes. We applied the weighted segmented regression with break-point estimation to detect the linear piecewise relationship between SDI and high LDL-C disease burden. Results Globally, 3.00 million (95% uncertainty interval [UI], 2.35–3.76 million) people in 1990 and 4.40 million (95% UI, 3.30–5.65 million) people died from high LDL-C in 2019. The absolute annual burden from deaths and DALYs attributed to high LDL-C increased by 46% (95% UI, 35–56%) and 41% (95% UI, 31–50%) from 1990 to 2019. The age-standardized SEV, death, and DALY was decreased by 9% (95% UI, −11 to −8%), 37% (95% UI, −41−33%), and 32% (95% UI, −37 to −28%), respectively, during the study period. There was a negative association between SDI and high LDL-C-related age-standardized death and DALY rates when SDI surpassed 0.71 and 0.71, respectively. Conclusion Although the overall age-standardized burden of high LDL-C is controlled in the past 30 years, it remains increasing in moderate SDI countries, and decreasing trends are disappearing in high SDI countries. New challenges require new actions stratified by countries with different SDI levels.
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Affiliation(s)
- Heyue Du
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyang Shi
- Department of Guideline and Rapid Recommendation, Chinese Evidence-Based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiong-Fei Pan
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Ministry of Education Key Laboratory of Environment and Health and State Environmental Protection Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Xueli Yang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Lingmin Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yazhou He
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Ye Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Department of Guideline and Rapid Recommendation, Chinese Evidence-Based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Sheyu Li, ;
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Cohen O, Shapira S, Furman E. Long-Term Health Impacts of Wildfire Exposure: A Retrospective Study Exploring Hospitalization Dynamics Following the 2016 Wave of Fires in Israel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095012. [PMID: 35564404 PMCID: PMC9099700 DOI: 10.3390/ijerph19095012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 01/27/2023]
Abstract
Background: Climate-related events, including wildfires, which adversely affect human health, are gaining the growing attention of public-health officials and researchers. Israel has experienced several disastrous fires, including the wave of fires in November 2016 that led to the evacuation of 75,000 people. The fires lasted six days (22–27 November) with no loss of life or significant immediate health impacts. The objective of this study is to explore the long-term hospitalization dynamics in a population exposed to this large-scale fire, including the effects of underlying morbidity and socio-economic status (SES). Methods: This is a retrospective crossover study, conducted in 2020, analyzing the electronic medical records of residents from areas exposed to a wildfire in northern Israel. The study spans from one year before exposure to two years after it (22 November 2015–27 November 2018). The hospitalization days during the study period were analyzed using the Poisson regression model. The rate of hospitalization days along with 95% confidence intervals (CIs) were plotted. Results: The study included 106,595 participants. The median age was 37 (IQR = 17–56), with a mean socio-economic ranking of 6.47 out of 10 (SD = 2.01). Analysis revealed that people with underlying morbidity were at greater risk of experiencing long-term effects following fires, which was manifested in higher hospitalization rates that remained elevated for two years post-exposure. This was also evident among individuals of low socio-economic status without these background illnesses. Conclusions: Healthcare services should prepare for increased hospitalization rates during the two years following wildfires for populations with underlying morbidity and those of low socio-economic status. Implementing preventive-medicine approaches may increase the resiliency of communities in the face of extreme climate-related events and prevent future health burdens. Additional research should focus on the specific mechanisms underpinning the long-term effects of wildfire exposure.
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Affiliation(s)
- Odeya Cohen
- Department of Nursing, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva 8410501, Israel
- Correspondence: ; Tel.: +972-86477737
| | - Stav Shapira
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer Sheva 8410501, Israel;
| | - Eyal Furman
- Maccabi Healthcare Services, Haifa 3508510, Israel;
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Sagy I, Cohen Y, Nahum Y, Pokroy-Shapira E, Abu-Shakra M, Molad Y. Lower socioeconomic status worsens outcome of patients with systemic lupus erythematosus independently of access to healthcare. Lupus 2022; 31:532-540. [PMID: 35341361 DOI: 10.1177/09612033221084518] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Socioeconomic status (SES) has been found to be associated with worse outcomes of systemic lupus erythematosus (SLE). The impact of national health insurance on SLE outcomes has not been explored. METHODS A retrospective inception cohort of patients older than 18 years with SLE diagnosed and followed in lupus clinics of two large tertiary medical centers were included. Patients were stratified into three groups by SES: lower 25th quantile, middle 25th-75th quantile, and upper 75th quantile. Primary outcomes were all-cause mortality, development of end-stage kidney disease (ESKD), and score ≤ 4 on the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI 2K) at the last visit. RESULTS We identified 617 patients (548 females, 88.8%) with a median follow-up of 15 years (range, 8.0-23.0). Compared to the middle and upper SES groups, the lower SES group was characterized by younger age at disease onset (31.5 years vs. 34.3 and 37.4 years, respectively, p = 0.011) and higher rate of lupus nephritis (42.7% vs. 35.7% and 23.8%, respectively, p = 0.002). In multivariate models, patients in the middle and upper SES groups had a significantly lower risk of mortality (HR = 0.45; 95% CI, 0.24-0.82, p = 0.010) and ESKD (HR = 0.24; 95% CI, 0.08-0.73, p = 0.012), with no effect on the rate of SLEDAI 2K ≤ 4 (OR = 1.49; 95% CI, 0.92-2.40, p = 0.09). CONCLUSION Even within a health system that provides high and equal accessibility to medical care, low SES is associated with worse outcomes of SLE. Policymakers should focus on managing possible barriers that prevent patients of lower SES from obtaining optimal care.
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Affiliation(s)
- Iftach Sagy
- Rheumatic Diseases Unit, 26746Soroka University Medical Center, Beer Sheva, Israel.,Clinical Research Center, 26746Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yarden Cohen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yehudit Nahum
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elisheva Pokroy-Shapira
- Institute of Rheumatology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mahmoud Abu-Shakra
- Rheumatic Diseases Unit, 26746Soroka University Medical Center, Beer Sheva, Israel.,Clinical Research Center, 26746Soroka University Medical Center, Beer Sheva, Israel
| | - Yair Molad
- Institute of Rheumatology, 36632Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Marcus EL, Jacobs JM, Stessman J. Prolonged mechanical ventilation and caregiver strain: Home vs. long-term care facility. Palliat Support Care 2022; 21:429-437. [PMID: 35266449 DOI: 10.1017/s147895152200027x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The number of patients treated with prolonged mechanical ventilation (PMV) is steadily rising. Traditionally treated within specialized long-term care facilities (LTCFs), healthcare providers are increasingly promoting homecare as a technologically safe, humane, and cheaper alternative. Little is known concerning their informal caregivers (ICGs), despite their crucial role in facilitating care. This study examines caregiver strain among the primary ICG of PMV patients treated at home vs. LTCF. METHOD This study was an observational cross-sectional study. The study enrolled 120/123 PMV patients ≥18 years within the study region (46 treated with homecare/74 treated at the LTCF) and 106 ICGs (34 ICGs/46 homecare patients and 72 ICGs/74 LTCF patients). Caregiver assessment included the 13-item Modified Caregiver Strain Index (Mod CSI) (0-26 maximum); patient assessment included symptom burden (the revised Edmonton Symptom Assessment System). RESULTS The mean age of ICGs was 58.9 years old; 60.4% were females; 82.1% were married; 29.2% were patient's spouses; and 40.6% were patient's children. The total Mod CSI was 13.58 (SD 6.52) and similar between home vs. LTCF (14.30 SD 7.50 vs. 13.26 SD 6.03, p = 0.50), or communicative vs. non-communicative patients (13.50 SD 7.12 vs. 13.64 SD 6.04, p = 0.93). Hierarchical analysis identified three clusters of caregiver strain, with ICGs at home vs. LTCF reporting significantly lower mood strain, higher burden, and similar levels of lifestyle disturbance. In adjusted models, homecare was significantly associated with reduced mood strain and increased burden, while increased patient symptomatology was significantly associated with total strain, mood, and burden strain clusters. SIGNIFICANCE OF RESULTS Recognizing the different patterns of caregiver strain at home or LTCF is a prerequisite for addressing their palliative care needs and improving the wellbeing and resilience of informal caregivers, who often play a critical role in deciding whether to treat the PMV patient at home or LTCF.
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Affiliation(s)
- Esther-Lee Marcus
- Chronic Ventilator-Dependent Division, Herzog Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jeremy M Jacobs
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Jerusalem Home Hospital Unit, Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel
- Department of Geriatrics and Geriatric Rehabilitation, Hadassah Medical Organization, Jerusalem, Israel
- Institute for Aging Research, Hadassah Medical Organization, Jerusalem, Israel
| | - Jochanan Stessman
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Jerusalem Home Hospital Unit, Institute of Geriatric Medicine, Clalit Health Services, Jerusalem, Israel
- Department of Geriatrics and Geriatric Rehabilitation, Hadassah Medical Organization, Jerusalem, Israel
- Institute for Aging Research, Hadassah Medical Organization, Jerusalem, Israel
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Socioeconomic disparities and household crowding in association with the fecal microbiome of school-age children. NPJ Biofilms Microbiomes 2022; 8:10. [PMID: 35241676 PMCID: PMC8894399 DOI: 10.1038/s41522-022-00271-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/28/2022] [Indexed: 11/08/2022] Open
Abstract
The development of the gut microbiome occurs mainly during the first years of life; however, little is known on the role of environmental and socioeconomic exposures, particularly within the household, in shaping the microbial ecology through childhood. We characterized differences in the gut microbiome of school-age healthy children, in association with socioeconomic disparities and household crowding. Stool samples were analyzed from 176 Israeli Arab children aged six to nine years from three villages of different socioeconomic status (SES). Sociodemographic data were collected through interviews with the mothers. We used 16 S rRNA gene sequencing to characterize the gut microbiome, including an inferred analysis of metabolic pathways. Differential analysis was performed using the analysis of the composition of microbiomes (ANCOM), with adjustment for covariates. An analysis of inferred metagenome functions was performed implementing PICRUSt2. Gut microbiome composition differed across the villages, with the largest difference attributed to socioeconomic disparities, with household crowding index being a significant explanatory variable. Living in a low SES village and high household crowding were associated with increased bacterial richness and compositional differences, including an over-representation of Prevotella copri and depleted Bifidobacterium. Secondary bile acid synthesis, d-glutamine and d-glutamate metabolism and Biotin metabolism were decreased in the lower SES village. In summary, residential SES is a strong determinant of the gut microbiome in healthy school-age children, mediated by household crowding and characterized by increased bacterial richness and substantial taxonomic and metabolic differences. Further research is necessary to explore possible implications of SES-related microbiome differences on children's health and development.
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Unger S, Orr Z, Avraham Alpert E, Davidovitch N, Shoham-Vardi I. Social and structural determinants and their associations with patient experience in the emergency department. Int Emerg Nurs 2022; 61:101131. [PMID: 35217412 DOI: 10.1016/j.ienj.2021.101131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Improving patient experience and satisfaction in the emergency department (ED) is challenging but beneficial. Previous studies have shown an association between social and structural factors and patient satisfaction. This study examined the structural and social factors related to the ED patient experience among Jewish and Arab patients in a Jerusalem hospital. METHODS A cross-sectional study was conducted among ED patients in a Jerusalem hospital. Data were collected via questionnaires. The sample included 257 Jewish patients and 170 Arab patients. The outcome variable was a positive or negative ED experience. RESULTS Jewish and Arab patients had different factors related to ED experience. Cultural differences, including a language barrier and access to information, were associated with a negative experience among Arab patients. Among Jewish patients, frequent use of community health services was associated with a negative ED patient experience. CONCLUSION This study shows an association between social and structural factors and patient experience, illustrating gaps for and vulnerability of different ethnic groups that affect their experience with healthcare services. Understanding these issues and implementing solutions formulated at the institutional and national levels can promote equity by providing structurally competent care.
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Affiliation(s)
- Shifra Unger
- Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel; Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Zvika Orr
- Faculty of Life and Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Nadav Davidovitch
- Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Ilana Shoham-Vardi
- Faculty of Health Sciences, Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
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Wolf I, Waissengrin B, Zer A, Bernstein-Molho R, Rouvinov K, Cohen JE, Cherny NI, Bar-Sela G. Implementation of the ESMO-Magnitude of Clinical Benefit Scale: real world example from the 2022 Israeli National Reimbursement Process. ESMO Open 2022; 7:100379. [PMID: 35121523 PMCID: PMC8818899 DOI: 10.1016/j.esmoop.2021.100379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 01/16/2023] Open
Affiliation(s)
- I Wolf
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - B Waissengrin
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Zer
- Institiute of Oncology, Rambam Health Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - R Bernstein-Molho
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Oncology Division, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - K Rouvinov
- The Legacy Heritage Oncology Center, Dr Larry Norton Institute, Soroka Medical Center, and Ben-Gurion University, Beer-Sheva, Israel
| | - J E Cohen
- Sharett Institute of Oncology and The Wohl Institute for Translational Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - N I Cherny
- Institute of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Bar-Sela
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Cancer Center, Emek Medical Center, Afula, Israel
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